In the present study, the effects of blood transfusion, duration of hemodialysis (HD) and infection by human T cell leukemia virus I (ATLV/HTLV) or HB virus on lymphocyte subpopulations in HD patients were studied using monoclonal antibodies. The results were as follows. 1) As the duration of HD increased, so did the percentages of OKT8⁺ cells, while the OKB1⁺ cells decreased. 2) Leu7⁺ cells from the patients undergoing HD treatment decreased significantly with blood transfusion. The OKT4/OKT8 ratio did not change significantly. 3) Although the OKT4/OKT8 ratios show wide variance in HD patients positive for anti-ATLA antibody (Ab), they were significantly decreased compared to those in patients negative for anti-ATLA Ab, and most of the patients with low OKT4/ OKT8 ratios in the blood-transfused group were positive for anti-ATLA Ab or under long-term HD treatment. 4) Lymphocyte subpopulations were not significantly different in HBs antigen (Ag)-positive patients and anti-HBs Ab-positive ones.
From these results, it was concluded that the duration of HD and the presence of anti-ATLA Ab are related in part to the altered lymphocyte subpopulations in HD patients. Therefore, the decrease of the OKT4/OKT8 ratio caused by blood transfusion as previously reported may be due to certain viral infections such as ATLV/HTLV-I and other viruses.

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β₂-microglobulin (β₂-MG) was recently recognized as the new type amyloid protein in chronic dialysis patients. Significant reduction of plasma β₂-MG without sieving effect in the hemofiltration using PMMA membrane suggested the specific adsorption of β₂-MG on PMMA membrane. Our examination revealed the venous and specific adsorption effects of PMMA (B-1 but not B-2), and PAN membrane. Cuprophan membrane showed no adsorption effects at all. The results suggest that some kinds of uremic plasma solutes as well as β₂-MG could be removed by membrane-specific adsorption mechanism.

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Parathyroidectomy for renal osteodystrophy caused by secondary hyperparathyroidectomy (2°HPT) in patients with chronic renal failure has been clinically evaluated as an effective procedure. However, there are few reports showing the histological features of the parathyroid gland (PTG) or evidence for the parathyroid secretory activity of oxyphil cells in 2°HPT. The oxyphil cells of the PTG have been considered to be an inactive and involutional form not associated with excess hormone production. Recently, it has been reported that PTG oxyphil cells may produce hormones and participate in 2°HPT. This is because the properties of PTG oxyphil cells have been elucidated and some reports of rare functioning oxyphil cell adenomas in primary hyperparathyroidism (1°HPT) have been published. We undertook subtotal parathyroidectomy with autotransplantation in 5 hemodialyzed patients diagnosed as 2°HPT. We studied them in detail histologically and examined the significance of the enlarged oxyphil cells in 2°HPT. Morphologically, all PTG in these 5 cases were composed of hyperplastic chief exyphil and transitional oxyphil cells, generally appearing as a mixture type. In 3 cases, chief cell hyperplasia was predominant and oxyphil cell hyperplasia formed small cell foci. In the other 2 cases, chief cell hyperplasia and oxyphil cell hyperplasia occurred in almost the same proportions, but the latter was rather predominant in some areas, showing nodular overgrowth, as if compressed chief cell hyperplasia were present. The main ultrastructual features of these oxyphil cells were numerous densely packed mitochondria characteristic of oxyphil cells, inconspicuous rough endoplasmic reticulum, Golgi complex and secretoty granules. These ultranstructual observations taken together with the previously cited reports on oxyphil cell activity in homone production idicate that PTG oxyphil cells may be hormonally active in connection with Ca metabolism and that oxyphil cell hyperplasia may also be the cause of 2°HPT just as it is in 1°HPT.

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A psycho-sociological study was conducted on 20 patients with or without adequate water control. Fourteen of 20 patients had adequate water control with an average rate of weight gain less than 4% of the dry body weight.
Six of the patients had poor water control with an average weight gain of more than 6%.
To evaluate the social status as well as the level of understanding on hemodialysis, we used 50 different questions. Psychological evaluation was conducted using the Y-G, Ucida and Kraepelin, and CAS tests.
Results: 1) Patients with poor water control had various problems within the family as well as in their roles in society, as compared with the patients with adequate water control. 2) The level of understanding of hemodialysis was poor among those patients with poor water control. 3) The Y-G test revealed a significant difference between patients with and without adequate water control. 4) The Uchida and Kraepelin test showed that the quantity of work done by those patients with poor water control was significantly less than those with adequate water control. It was suggest that the level of intelligence in the former group of patients was probably inferior to that in the latter group. 5) The CAS test revealed that those patients with poor water control showed poor self-management, and were not so resistant to frustration.
From this, we conclude that in those patients with poor water control, various psycho-sociological problems are one of the centributing factors in their maladaptation to long term hemodialysis.

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Hemodialysis (HD) for chronic renal failure (CRF) is usually begun with frequent and brief treatment, administered 2 or 3 times a week. We tried once a week HD in 7 patients whose urine volume was still over 1, 000ml daily, to determine whether the method was useful, considering the duration of the method, change in the slope of the regressin line of reciprocal serum creatinine concentration (1/SCr), and change in the urine volume. Mitch et al. reported that the 1/SCr declined linearly with time in most CRF patients, and was useful for predicting when dialysis was required, or for determining the effects of therapy. We examined the same problem in our patients with the following results:
1. Reciprocal serum creatinin concentration. 1) 1/SCr declined linearly with time in 22 of 50 CRF patients (44%), and about 60% showed a linear regression in the terminal stages of CRF. 2) The effects of therapy is an important factor to prevent linear regression of the 1/SCr. 2. Once-a-week hemodialysis. 1) In 5 of 7 patients, once-a-week HD was continued for more than a year. The longest duration was 23 months. 2) The slope of the 1/SCr regression line decreased after once-a-week HD, in 5 of 7 patients. 3) The period from the time when serum creatinin 10mg/dl to the beginning of 2 or 3 times a week HD was significantly longer than in the once a week HD group. 4) The volume decreased more slowly in the once-a-week HD group. 5) Once-a-week HD may be tried in patients whose urine volume is still maintained and is in relatively good control.

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Circulatory diseases, particularly atherosclerosis, is the most common cause of death in patients on chronic hemodialysis (HD). Hemostatic factors, such as platelet aggregability (PLAG) and prostaglandins (PG) generated by the platelets and vascular walls, strongly influence on the occurrence and the development of atherosclerosis. In this study, in order to investigate the effect of dialysis membrane materials on PLAG and circulatory PG system, changes of PLAG and plasma PG during HD were determined in ten non-diabetic patients. The patients were dialyzed with regenerated cellulose (cuprophane: CUPR) or synthetic polymer (polymethylmethacrylate: PMMA) membrane. Blood samples were collected periodically before and during HD, and PLAG was measured from the platelet aggregation curve elicited by collagen (CL), ADP or epinephrine (EP). Plasma 6-keto-PGF_1α and thromboxane B₂ (TXB₂) were determined by radioimmunoassay after extraction and purification. Hemodialysis leukopenia was less with PMMA than with CUPR, and platelet counts were not changed with either membranes. Although the PLAG elicited by ADP was no different with the two membranes, the maximal aggregation rate for CL (0.5mcg/ml) or EP (1mcM) was significantly more reduced in PMMA than in CUPR (CL at 15min: 44±10 [mean±SD] vs 73±7%, p<0.01; EP at 60min: 36±4 vs 58±9%, p<0.025). Plasma 6-keto-PGF_1α increased after starting HD, then tended to return to pre-dialysis levels with both PMMA (261±76, 519±137, 381±83pg/ml for pre-HD, 15min, 120min respectively) and CUPR (237±67, 513±89, 358±41pg/ml for pre-HD, 15min, 120min respectively). On the other hand, plasma TXB₂ increased and remained high during HD with CUPR (401±35, 822±194, 635±70pg/ml for pre-HD, 15min, 120min respectively), but did not change significantly with PMMA (420±97, 395±75, 381±53pg/ml for pre-HD, 15min, 120min respectively). These results suggest that HD with PMMA membrane compared to CUPR may exert a more favorable effect on the hemostatic system and may inhibit the progression of atherosclerosis in dialyzed patients.

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Forty-four patients under regular hemodialysis for more than 10 years (L-patients) were investigated with regard to their bone metabolism and calcification of the vessels. Age-sex matched patients under dialysis for 3-4 years were used as controls. Although many L-patients were administerd more calcitonin, and less active vitamin D than the controls, their serum calcium level was significantly higher than that of the controls. The calcification of blood vessels was more frequent in the L-patients than in the controls. The serum PTH and osteocalcin levels were siificantly higher than in the controls, indicating that the bone turnover in this group was higher than in the controls. The supression of PTH secretion by serum calcium is less effective than it is in the controls, and the parathyroid glands of these patients may have autonomy, leading to high bone turnover and calcification of vessels.
The more active supression of secondary hyperparathyroidism in the early course of hemodialysis is necessary to prevent these complications.

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Patients with chronic renal failure (CRF) have special pharmacokinetics. We studied the changes in plasma amikacin (AMK) levels after the intramuscular (i.m.) administration of 200mg of AMK (4mg/kg) in three groups of patients with CRF: Group I with severely depressed renal function, Group II treated with HD 3 times per week, and Group III treated with continuous ambulatory peritoneal dialysis (CAPD). In Group I 24hr after i.m. injection, the plasma level of AMK was 15.8±1.7μg/ml at 1hr and 7.8±0.4μg/ml. The half-disappearance time (T1/2) was markedly prolonged to 21.7hrs compared with the normal time (1.7-1.9hrs). In Group II, the plasma level was 13.0±1.4μg/ml at the start of HD, then it gradually decreased to 4.3±0.5μg/ml at 5hrs HD. The T1/2 was 2.9hrs, indicating good dialyzability of AMK. Therefore, half of the initial dose (2mg/kg) was considered to be suitable to consistently maintain an optimal plasma AMK level. In Group III (CAPD), AMK eliminated into the effluent in 24hrs was about 30mg and the T1/2 was about 24hrs, indicating poor disappearence from the blood to the peritoneal dialysate. From these results, additional administration of 1mg/kg/day was considered to be reasonable for a good plasma AMK level during CAPD. We also measured the AMK concentrations in the plasma using dialysate containing 200mg of AMK in each 2l bag. In this case, the plasma level of AMK was 20μg/ml on the first day, and it increased to over 40μg/ml on the second day and maintained a high level for 5 days. This shows the high permeability of AMK from the dailysate into the blood through the peritoneum. In conclusion, the dialyzability of AMK from the blood is very high in the cases treated with HD. With CAPD treatment, AMK is well absorbed from the dialysate into the blood but is poorly removed from the blood to the dialysate.

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Uroflowmetry (UFM) was examined in 23 male hemodialysis patients. The maximum flow rate (MFR) and the average flow rate (AFR) were judged from the UFM curve, and micturition disturbance was diagnosed in the patients by AFR and MFR using a normal male nomogram. Then we studied their relationships to micturition disturbances, durations of hemodialysis, urinary tract infections (UTI), volumes of urine, serum levels of BUN and creatinine and median nerve conduction velocities.
The results were as follows; 1) Bacteriuria was detected in 10 cases (43.5%) and UTI in 4 cases (17.4%). The number of patients with bacteriuria increased in long-term hemodialysis. 2) Although the patients had no residual urine, there was a negative relationship between bacteriuria and volume of urine. 3) The nerve conduction velocities were normal in almost all cases (92.3%). 4) Nine cases in long-term hemodialysis with little urine volume were diagnosed as micturition disturbance according to the UFM curve.
These results suggest that patients in long-term hemodialysis have micturition disturbance on UFM and high frequencies of UTI.

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